Thursday, October 2, 2008

the choices we make will haunt us...

i was sitting at the receptionists' desk, doing paperwork, while the receptionist talked on the phone to a distraught owner. i could hear her voice - though not the words - clearly through the receiver. the receptionist, obviously disturbed, covered the mouthpiece with her hand and gestured to me."this woman says that while she was at work, her boyfriend smacked the cat, and now it's nose won't stop bleeding. it's been bleeding for an hour." i suppressed the gag reflex about to overwhelm me, and i suggested that she bring the cat in for an exam.

an hour later, i had mostly forgotten about that phone call. regrettably, we get many such phone calls, and we never see the animals. lo and behold, a couple hours later, a technician walked past me to the back. she was carrying a wicker basket. curled in it was a soft, light grey tabby cat - maybe 9 months old.

i followed her, because it was obviously a "tech to the front" (code for get your ass up here now, we've got a real emergency). removing the kitty from the basket, i felt sick. he was stuporous, barely responsive to my touch. both pupils were tiny (miotic) - what we call "snake pupil" in the vet world. the 3rd eyelids were raised partially over both eyes. blood was caked underneath both nostrils. i gently palpated the skull, and to my relief, i couldn't find any obvious fractures.

the cat had obviously suffered massive head trauma of some sort. i realized that this was the kitty that had been called about earlier when the tech recited the history to me. as i looked at this cat, at what a human had done to it in a rage, i felt my heart break a little bit.

the owners were put in an exam room, waiting to see me. i paced back and forth for a while, as the techs placed the kitty in an oxygen chamber (oxygen is extremely important in head trauma patients) on a soft bed. when i felt calm enough, i went into the room. i was confronted with a young couple - a girl in her early 20s, sobbing quietly, and her boyfriend - a very tall, imposing figure. to my surprise (and confusion), he was crying, too. later, as i discussed these events with several colleagues and technicians, i came to understand that abusive people - whether towards animals or people - are typically very remorseful of what they did. having never been in a relationship or even known anyone abusive - physically, verbally, or otherwise - i had no experience with this - and was thus surprised to see the pentinent boyfriend shedding real tears.

as the story went, the cat had been on the couch. the boyfriend was annoyed by something it did and he "lightly" smacked the cat. he fell to the (carpeted) floor, a few feet at most, and that was how the damage had been done. now, i wasn't there. and i'm not a judge or a jury or omnipresent. i have no way of knowing if what he told me was true. i just know that the cat i had just examined had suffered massive head trauma. more massive than thwacking his head on a carpeted floor should have inflicted.

i discussed his grave condition with the owners, his poor prognosis given the likely seriousness of his head trauma, and the cost of hospitalizing him for the night. the owners had no money. the girlfriend sobbed and cried and begged me to think of some way to help her kitty. i felt even sicker. in the end, the girl surrendered the cat to me - signed it over. i was relieved. the cat was being removed from what was - in all likelihood - an abusive, dangerous situation. still, i felt terrible for the girl. it was her cat - and her boyfriend had done this to it while she was away at work.

they visited the kitty one more time, and then they left him in my care. one of the technicians - being soft-hearted - as most of us in the vet world tend to be - offered to use her "pet bucks" to pay for his care - if i thought he had a chance. i was skeptical, but i recommended that we give him at least 24 hours to see if he responded to medical treatment of head trauma (oxygen, mannitol, pain control, etc).

a few hours later, the receptionist found me and told me that cat's owner (the girl) was on the phone, that she had found money, and that she wanted to know if she could have the kitty back. i was stuck. on the one hand, the cat had obviously been hurt badly by the girl's boyfriend. on the the other hand, i couldn't imagine if someone i loved hurt one of my animals and then i had to give that animal up because i couldn't afford $600-800 to treat it. i felt sick having to make this decision. keep the cat? give him back to his obviously loving owner (not counting the boyfriend)?

in the end, i returned the cat to its owner - rationalizing that due to its head trauma, it probably only had a few days left of life anyway. they came and picked up the cat so that they could transfer it to a (cheaper) nearby clinic. i called the doctor a few days later to check on what had happened to kitty. to my surprise, kitty recovered - albeit not completely, he still stumbled when walking - in a few days and went home.

i can only hope that i made the right decision in the end. the hardest part is that i will never know.

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DISCLAIMER

Any similarity between my stories and any person or animal, living or dead, is strictly a coincidence. Names, breeds, sexes, and details of the stories have been changed to protect the guilty and innocent alike.

About Me

I am an emergency veterinarian in North Carolina. Despite the crazy people I deal with, the awful cases of injured and sick animals, and the overall stress of emergency work, I absolutely love what I do. Happily married since I was 20, I have a wonderful husband who has a PhD in Mathematics, and a daughter around whom our world currently revolves. We also have a zoo living in our house that can be alternately wonderful and maddening. There are cats, parrots, and a dog who is very low on the totem pole. Our days are never dull and we are learning to balance the demands of work and family.
If you'd like to contact me: homelessparrot@gmail.com

Human gross-ness

Followers

Medical terminology

Lactate - a salt/ester of lactic acid that is produced as energy for a cell when oxygen levels are low. In critically ill animals, elevated lactate can be an indicator of inadequate blood flow to organs (perfusion), decreased delivery of oxygen, and/or decreased oxygen uptake. Values > 6-7 are usually considered to be poor prognostic indicators for survival.

GI sloughing: when the cells lining the GI tract die (can be secondary to MANY things, including heatstroke) with resulting bloody diarrhea, bacterial translocation into the bloodstream and sepsis

TTJ: transfer to jesus: code for when an animal needs to be euthanized or die

DIC: disseminated intravascular coagulation: a very, very bad thing - when the hemostatic system gets out of whack, and clots start forming in the blood vessels until all clotting factors are wasted. once those are gone, internal hemorrhage ensues, followed by death, usually. also known as "death is coming"

Pleural effusion - fluid contained in the pleural space (chest) - this is not the same as fluid in the lungs (see pulm edema) - in cats can be caused by infection in the chest, heart failure, cancer, FIP, feline leukemia, FIV, and in some cases, the cause is never found (idiopathic)

Anisocoria - unequal pupil size (related to any number of causes including brain damage/head trauma)

Sepsis - refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.

Nephrectomy - kidney removal

Splenectomy - removal of spleen

Pulmonary edema - condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately ( can be caused by heart failure, electrocution, drowning, too many IV fluids, to name a few)

Tick borne diseases - any of a myriad of diseases transmitted by ticks - including but not limited to Rocky Mtn Spotted fever, Lyme disease, Ehrlichia

Fine needle aspirate - A method of sampling in which a needle is used to suck in cells or tissue bits for diagnoses (good for diagnosing masses/lumps)

Blood glucose - The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence of insulin (normal range in a dog/cat is 75-100)

Diseases I see/treat frequently

Dystocia - difficulty birthing. May be responsive to oxytocin administration (Pitocin, as in people) but may require c-section.

DKA - diabetic ketoacidosis: the extreme end of the diabetic scale. A patient that is diabetic can develop DKA when other diseases make the blood glucose hard to regulate. Other diseases that are commonly associated include urinary tract infection, pancreatitis, pyometra, skin infection, and cancer. In DKA, the body starts metabolizing fat and producing acids that cause a drop in blood pH, nausea, weakness, severe dehydration, electrolyte derangments, and death.

DCM - dilated cardiomyopathy: an idiopathic (cause unknown) cardiac disease in which the heart chambers become very thin/dilated, and cardiac output drops radically. Causes arrhythmias, tachycardia, and sudden death. Seen in large breed dogs like Dobermans, Great Danes, etc.

Lymphoma - cancer of the white blood cells, the most common and treatable form of cancer in dogs

Blocked cat - slang term for a male cat with a plug of mucus and crystals obstructing the urethra (fairly common in male cats) definitely a life-threatening because urine can't get out of the body! If present long enough, causes shock, acute renal failure, hyperkalemia (elevated potassium), coma, and death. Symptoms include straining in the litterbox, yowling while trying to urinate, producing small, bloody drops of urine (also symptoms of feline cystitis, a non-lethal condition)

GDV - stands for gastric-dilatation and volvulus - a condition of large breed, deep-chested dogs (usually) in which the stomach rotates 180 degrees on its axis and thus - nothing can enter or leave, considered the "mother of all emergencies" - it warrants immediate surgery and carries a guarded prognosis

IMHA - immune-mediated hemolytic anemia. A disease in which the immune system attacks the red blood cells and destroys them. It causes profound anemia and is life-threatening. Causes are primary (no known cause) and secondary ( tick borne disease, cancer, and heavy metal intoxication). Treatment is immunosuppression with drugs primarily. Prognosis is guarded at best.